Description:

E5204 Patient Bowel Function/Uniscale Questionnaire NCT00303628 Combination Chemotherapy With or Without Bevacizumab in Treating Patients Who Have Had Surgery for Stage II or Stage III Rectal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=08ED057C-100B-64FF-E044-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=08ED057C-100B-64FF-E044-0003BA3F9857

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Versions (3) ▾
  1. 8/27/12
  2. 1/9/15
  3. 6/16/15
Uploaded on:

June 16, 2015

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License:
Creative Commons BY-NC 3.0 Legacy
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E5204 Patient Bowel Function/Uniscale Questionnaire NCT00303628

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  1. StudyEvent: E5204 Patient Bowel Function/Uniscale Questionnaire
    1. No Instruction available.
Header
Reporting Period
Patient Bowel Function
Overall, would you say that you had problems with your bowel function in the last week?
In the past week, have you had a problem causing you to get up at night to have a bowel movement?
In the past week, have you had a problem causing you to lose control of your bowel movements?
In the past week, have you had a problem causing you to have a bowel movement within 30 minutes of a prior bowel movement?
In the past week, have you had to wear protective clothing or a pad in case you lost control of a bowel movement?
In the past week, have you had a problem causing you to be unable to tell the difference between a stool and gas?
In the past week, have you had a problem causing you to have stools that are liquid?
In the past week, have you found that once you feel the urge to have a bowel movement, you must do so within 15 minutes to avoid an accident?
In the past week, have you had cramping with a bowel movement?
Is your cramping
In the past week, have you had blood in your bowel movement?
Check the description that best describes the amount of blood in your bowel movement
In the past week, how much have problems with bowel movements affected your normal activities?

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